Needle Exchange Programs: Policy Recommendations for Maryland

These recommendations were informed by a multi-stakeholder harm reduction meeting held at JHSPH in October 2015 and were developed by meeting participants. They do not necessarily represent the views of The Johns Hopkins University.

eedle exchange programs are designed to reduce increase injection drug use.7 the risk of HIV/AIDS, hepatitis C and other n One study found that there was no increase in the num- infections associated with needle sharing among ber of discarded needles two years after implementation Ninjection drug users. of Baltimore City’s needle exchange program.8 Summary of current Maryland state law Policy recommendations During the 2016 Regular Session the General Assembly 1) Permit secondary distribution of sterile needles and sy- passed SB97, which repealed the Prince George’s County ringes. Participants should be able to take supplies from AIDS Prevention Sterile Needle and Syringe Exchange Pro- the exchange and give to others who are unable to travel gram and in its place established Opioid-Associated Disease to a needle exchange program. Prevention and Outreach Programs.1 These new programs 2) will provide substance use outreach, education, and referral People participating in needle exchange programs should receive prescriptions for naloxone, a drug that counters to treatment, which includes the exchange of hypodermic 9 needles and syringes by participants for sterile needles and the effects of opioid overdose. syringes. Local health departments or community-based Implementation considerations organizations may apply to the Maryland Department of n Needle exchange programs may be housed in local health Health and Mental Hygiene for authorization to operate departments as well as community based organizations such a program. specializing in a broad range of social support services. The existing needle and syringe exchange program in n Program staff and participants are currently not immune Baltimore City remains legally active. Program staff mem- from prosecution for drug possession crimes. bers and participants cannot be found guilty of possessing or distributing drug paraphernalia when the possession or n Needle exchange programs should include education distribution is a direct result of participating in the needle on risk of HIV and other infections, and referral to exchange program.2 substance use treatment and other healthcare and social services. Research evidence Nearly 200 needle exchange programs operate nationwide. n Organizations providing needle exchange services must Baltimore City started its first program in 1994. emphasize safe syringe disposal. In Los Angeles, pharma- cies often served as a source of sterile syringes, but did n Unsafe needle sharing is significantly reduced in localities not always properly dispose of used syringes.10 with needle exchange programs.3 n Police training is necessary to ensure law enforcement of- n Needle exchange programs have been shown to be effec- ficers understand changes in the law, standard operating tive in reducing HIV and hepatitis C infection among 4 procedures as well as the purpose and benefits of needle injection drug users. exchange programs. In Baltimore City, research suggests n Public funding of needle exchange programs is associated negative encounters between program participants and with a larger number of needles and syringes distributed, police continued to the influence needle exchange pro- which is in turn associated with lower rates of HIV infec- grams’ ability to provide services and clients’ willingness tion in those localities.5 to participate.11 n In Baltimore City, HIV infection attributed to drug use n New needle exchange programs should be encouraged to has fallen from 62% in 1994to 12% in 2011, a decrease provide more than one syringe per exchange. largely credited to the needle exchange program.6 n Studies show that needle exchange programs do not 1 MD. CODE ANN., HEALTH-GEN. §3-105. 7 Wodak A, Cooney A. (2006). Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the 2 MD. CODE ANN., HEALTH-GEN. §24-808. international evidence. Subst Use Misuse, 41(6): 777–813. 3 Wilson, D.P., Braedon, D., Shattock, A. J., & Fraser-Hurt, N. (2014). 8 Doherty, M.C., Junge, B., Rathouz, P., Garfein, R.S., Riley, E., & Vlahov The cost-effectiveness of harm reduction. International Journal of Drug D. (2000). The effect of a needle exchange program on numbers of Policy, 26(2): S5-S11. doi:10.1016/j.drugpo.2014.11.007 discarded needles: a 2-year follow-up. American Journal of Public Health, 4 Abdul-Quader, A.S., Feelemyer, J., Modi, S., Stein, E. S., Briceno, A., 90(6): 936-939. Semaan, S., Horvath, T., Kennedy, G. E., & Des Jarlais, D. C. (2013). 9 Harm Reduction Coalition. Understanding Naloxone. Retrieved from http:// Effectiveness of Structural-Level Needle/Syringe Programs to Reduce HCV harmreduction.org/issues/overdose-prevention/overview/overdose-basics/ and HIV Infection Among People Who Inject Drugs: A Systematic Review. understanding-naloxone/ AIDS and Behavior, 17(9): 2878-2892. doi:10.1007/s10461-013-0593-y 10 Quinn, B., Chu, D., Wenger, L., Bluthenthal, R.N., & Kral, A.H. (2014). 5 Bramson, H., Des Jarlais, D. C., Arasteh, K., Nugent, A., Guardino, V., Syringe disposal among people who inject drugs in Los Angeles: the Feelemyer, J., & Hodel, D. (2015). State laws, syringe exchange, and role of sterile syringe source. Int J Drug Policy, 5:905-10. doi: 10.1016/j. HIV among persons who inject drugs in the United States: History and drugpo.2014.05.008 effectiveness. Journal of Public Health Policy, 36: 212-230. doi:10.1057/ jphp.2014.54 11 Beletsky, L., Cochrane, J., Sawyer, A.L., Serio-Chapman, C., Smelyanskaya, M., Han, J., Robinowitz, N., & Sherman, S.G. (2015). 6 Maryland Department of Health and Mental Hygiene. (2012, December). Police Encounters Among Needle Exchange Clients in Baltimore: Drug Baltimore City HIV/AIDS Epidemiological Profile. Retrieved from http:// Law Enforcement as a Structural Determinant of Health. Am J Public phpa.dhmh.maryland.gov/OIDEOR/CHSE/Shared%20Documents Health,105(9):1872-9. doi: 10.2105/AJPH.2015.302681 /Baltimore-City.pdf

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